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Tips for Buying Long Term Care Insurance
By Mary Damiano
- Who decides when you’re eligible benefits?
Insurance companies have different criteria for
paying benefits. Some require only a doctor’s
order. Others base their coverage on the
policyholder’s ability to perform everyday tasks
such as bathing, dressing and feeding
themselves. These tasks are called Activities of
Daily Living, or ADLs. When an insurance company
uses ADLs as a guideline, the difference between
someone being able to perform these tasks with
physical assistance, supervised assistance can
mean the difference between eligibility and
ineligibility.
- Does the policy evaluate mental functions
when deciding eligibility? A person with
Alzheimer’s may be physically capable of
performing ADLs, yet they might forget where
they live and wander off or forget to take
medications. Unless the policy states that they
take mental functioning into consideration, the
policyholder with Alzheimer’s disease may be
denied coverage.
- Does the policy require that in order to
qualify for benefits, the policyholder needs
“one on one continual assistance”? This is a
very restrictive requirement and one that is
difficult to meet.
- Does the policy clearly explain claim-filing
procedures and the policyholder’s rights to
appeal decisions made by the company? It is very
important that you understand exactly what you
must do in order to get your benefits.
- Have you done a personal inventory of your
income and assets? This is important to see not
only if you will be able to afford the policy
over an extended amount of time, but also how
much you can afford in out-of-pocket expenses.
- Have you answered all medical questions
truthfully? When you get a policy, companies
usually ask some medical questions and some even
ask for a statement regarding your health from
your doctor. The company wants to make sure
you’re a good risk. When you file a claim.
However, the company may look for reasons to not
pay that claim, so they go over your medical
history with a fine tooth comb. If they discover
you were misleading about your health, claims
can be denied. No matter what the insurance
agent says, make as a full disclosure about your
medical history. If you can’t remember much,
refer the company to the doctor who treated you.
If you’re really not sure about something,
legally speaking, “I do not recall” is a much
safer answer than “I don’t know.”
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